ICFM Magazine, October 2006
One effective method of infant embalming utilizes a thoracic incision and hence a direct injection into the heart or the arch of the aorta. This method can only be implemented if the infant has not undergone a post mortem examination.
The arterial injection takes place directly into the left ventricle of the heart; drainage is received from the right atrium. Make a standard post mortem "Y" type of angular incision just below the clavicle toward the median line so that the two incisions meet on the median line at the level of the fourth rib.
Continue the "Y" incision down the median line to the lower border of the sternum. Here the tissue from the sternum and the ribs needs to be dissected.
Cut the ribs on both sides of the sternum with a sharp pair of scissors and be sure not to cut the upper end of the sternum loose from its articulation with the clavicle bones. Then, grasping the lower ends of the sternum, lift it up and bend it backwards toward the infant's face. Lift the exposed heart and carefully open up the pericardial sac so that you can free the heart from the confines of the sac.
While holding the heart, insert a curved medium sized arterial tube through the wall of the left ventricle in the direction of the aorta so that the end of the arterial injection tube lies within the chamber of the left ventricle.
No incision is necessary in the heart muscle to insert the arterial tube, because the muscular tissue will naturally fit tight around the arterial injection tube. It will not be necessary to ligate the arterial injection tube into the heart.
Drainage is obtained from the right atrium. You will not need to insert a drain tube, merely to make a small incision in the right atrium with a scalpel or sharp scissors and insert a pair of small spring forceps to hold the incision open.
To avoid swelling, you must be extremely careful to make sure that the amount of arterial fluid does not greatly exceed the amount of drainage. Inject 1 quart to 3 pints of mild arterial solution strength.
When using 2 concentrated ounces of a 5-index cosmetic-based arterial fluid, you should dilute this solution with a quality pre- or co-injection fluid to make 1 quart of fluid. Basically this is a waterless embalming technique.
Injection pressure should not exceed 1 to 1.5 pounds, and the rate of flow should be at a minimum. The procedure is simply a trickle effect injection.
It is not necessary to close the incision in the right atrium or the puncture incision in the left ventricle after arterial injection in completed.
Following completion of the arterial treatment, carefully place the heart back into its correct anatomical position in the thoracic cavity, return the sternum to its normal position and close the incision.
Your next step should be aspiration using an infant trocar and cavity treatment via injection of 8 to 12 ounces of concentrated low-odor cavity fluid.
I have used this method throughout my entire career. In the early years, we used these procedures and techniques without any consideration given to obtaining special permission from the family.
Times have changed. Since this technique creates an incision which closely resembles the "Y" type of incision used in performing thoracic autopsies, the liability risk to the funeral home is greatly increased.
Therefore, I strongly suggest that when you seek permission to embalm from the person executing the rights and duties of disposition, you include full procedural disclosures.